Practical tips for warfarin dosing and monitoring.

Abstract

Patients on warfarin and their physicians must constantly balance the risks of bleeding and clotting. We offer practical tips for safe and effective warfarin therapy, based on the practices of the Anticoagulation Clinic of The Cleveland Clinic.

Direct thrombin inhibitors: novel antithrombotics on the horizon in the thromboprophylactic management of atrial fibrillation

“…Other factors that can affect its dose response are liver dysfunction, genetic factors, changes in gut flora, patient compliance, and alcohol intake. 31 A very narrow therapeutic window along with pronounced variability in its dose response necessitates frequent checks and hospital visits. 32 Home monitoring has been touted as one possible solution; but adds to the initial cost and many patients may prefer first to choose this option.…”

Anticoagulation for non-valvular atrial aibrillation – towards a new beginning with ximelagatran

“…Warfarin exerts its pharmacokinetic effects by reducing the synthesis of vitamin K-dependent procoagulant factors II, VII, IX and X. Warfarin's dose response is influenced by numerous drug interactions (it is metabolized by the P450 enzyme complex), hepatic dysfunction, changes in the gut flora, and patient compliance and alcohol intake [30]. Warfarin has a very narrow therapeutic range, with marked variability in its dosage response that necessitates frequent venipuncture to maintain appropriate dosage [31].…”

Healthcare Professionals’ Knowledge and Counseling Practice on Warfarin Therapy at Tertiary Care Teaching Hospital, Addis Ababa, Ethiopia

“…Warfarin has been the mainstay oral anticoagulant agent for the last several decades despite its narrow therapeutic index [1]. It has become a successful agent for the medical management of thromboembolic diseases such as atrial fibrillation, mechanical heart valve replacement, deep vein thrombosis, pulmonary embolism, and valvular heart disease, among others.…”

“…Counseling patients with respect to their anticoagulant treatment is vital and significantly improves patient's knowledge and quality of anticoagulation [15]. Healthcare providers should counsel patients on need for frequent INR monitoring, common sign and symptoms of adverse drug events, precautionary measures to decrease trauma or bleeding, what to do if they miss dose(s), about potential drugs, herbals, food (vitamin K enrich diet) and alcohol interaction is also essential for better therapeutic outcome [1].…”